Pain cognition versus pain intensity in patients with endometriosis: toward personalized treatment

Pain cognition is independently associated with the health-related quality of life in endometriosis patients.

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Volume 108, Issue 4, Pages 679–686


Mieke A.W. van Aken, M.D., Joukje M. Oosterman, Ph.D., C.M. van Rijn, M.D., Ph.D., Magdalena A. Ferdek, M.Sc., Gé S.F. Ruigt, Ph.D., B.W.M.M. Peeters, Ph.D., Didi D.M. Braat, M.D., Ph.D., Annemiek W. Nap, M.D., Ph.D.



To explore how pain intensity and pain cognition are related to health-related quality of life (HRQoL) in women with endometriosis.


Cross-sectional questionnaire-based survey.


Multidisciplinary referral center.


Women with laparoscopically and/or magnetic resonance imaging–proven endometriosis (n = 50) and healthy control women (n = 42).


For HRQoL, two questionnaires: the generic Short Form Health Survey (SF-36) and the Endometriosis Health Profile 30 (EHP-30). For pain cognition, three questionnaires: the Pain Catastrophizing Scale (PCS), the Pain Vigilance and Awareness Questionnaire (PVAQ), and the Pain Anxiety Symptoms Scale (PASS). For pain intensity, the verbal Numeric Rating Scale (NRS).

Main Outcome Measure(s)

Association between pain intensity and pain cognition with HRQoL in women with endometriosis, and the differences in HRQoL and pain cognition between women with endometriosis and healthy controls.


Health-related quality of life was statistically significantly impaired in women with endometriosis as compared with healthy control women. The variables of pain intensity and pain cognition were independent factors influencing the HRQoL of women with endometriosis. Patients with endometriosis had statistically significantly more negative pain cognition as compared with controls. They reported more pain anxiety and catastrophizing, and they were hypervigilant toward pain.


Pain cognition is independently associated with the HRQoL in endometriosis patients. Clinicians should be aware of this phenomenon and may consider treating pain symptoms in a multidimensional, individualized way in which the psychological aspects are taken into account. In international guidelines on management of women with endometriosis more attention should be paid to the psychological aspects of care.

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Fertility and Sterility

Editorial Office, American Society for Reproductive Medicine

Fertility and Sterility® is an international journal for obstetricians, gynecologists, reproductive endocrinologists, urologists, basic scientists and others who treat and investigate problems of infertility and human reproductive disorders.